A Non-Invasive Womb Cancer Test Could Replace Painful Checks

Bleeding after menopause is the kind of symptom no one ignores. In the UK it sends a woman straight onto an urgent cancer pathway, and then through a run of internal scans and procedures that are uncomfortable, sometimes costly, and occasionally have to be repeated. For most of them the tests come back clear. Only five to ten percent of women investigated for that symptom turn out to have cancer.

A team at the University of Manchester has been working on a gentler way to sort out who actually needs all of that. Their test hunts for cancer cells in two samples a woman can give herself without any internal exam, one of urine and one of vaginal fluid. The point is to do the sorting up front, pointing clinicians toward the women who most likely need the full workup and clearing the many who do not far sooner.

Reported in Lancet Obstetrics, Gynaecology and Women’s Health, the combined urine and vaginal result flagged more than 80 percent of the cancers turned up in the study. Its negative predictive value for womb cancer was 98.8 percent, which in plain terms means a woman who got a clear result was very unlikely to have the disease. It performed best against the most aggressive cancers, catching 95.8 percent of high-grade tumours, and it flagged 96.4 percent of cancers that had already moved outside the womb.

Those figures come from a trial the team calls DETECT, short for Developing Tests for Endometrial Cancer detection. It enrolled 1,864 women who had come to hospitals across North West England with bleeding after menopause, among the biggest studies of its kind so far. Each woman gave a urine and a vaginal fluid sample before her usual clinical workup, and specialists in cell pathology checked each one for abnormal cells, with no knowledge of which women turned out to have cancer. In all, 115 of the women had cancer, 99 of them womb cancer.

One result stood out. In the Black women in the study, the test picked up every cancer, at 96 percent specificity. It is a small subgroup, so the finding needs confirmation. It still matters: in the UK, Black women die of womb cancer at twice the rate of White women, and a companion paper from the same team found that the tests used today are poorly tuned for patients from Black ethnic backgrounds.

The researchers are plain about what they have not shown yet. The samples were read by highly trained specialists, and it is not yet clear the accuracy would hold in an ordinary clinic. The test was only studied in women who already had symptoms, so how it performs in women without them is unknown.

“Bleeding after the menopause is understandably alarming for women because it can be a sign of cancer, but the vast majority of those investigated will not have the disease,” said Professor Emma Davidson, the lead researcher, who is also an honorary consultant in gynaecological oncology. “Our study shows that a simple test using urine and vaginal samples could help identify the women most likely to have cancer while safely reassuring many others much earlier in the diagnostic pathway.”

If it holds up in routine practice, the test could eventually move into primary care and community settings, closer to where women first raise the alarm. “If further studies confirm these findings in routine practice,” Davidson said, “this approach has the potential to transform care for thousands of women every year.”